In Reply: We appreciate the opportunity to
clarify the results of TADS. Drs Antonuccio and Burns interpret our results
as showing that fluoxetine offers no significant benefit over placebo, arguing
(we believe incorrectly) that exercise is a placebo treatment and is somehow
preferable to any of the TADS treatments. Drs Rifkin and Rifkin conclude that
for the study population as a whole CBT plus fluoxetine offers little or no
advantage over fluoxetine alone. In response, we note that TADS used the rate
of improvement and 12-week outcome on the Children’s Depression Rating
Scale, the rate of improvement and 12-week outcome on the RADS, and percentage
of patients much or very much improved on the CGI scale. Fluoxetine in combination
with CBT was superior to placebo and to CBT alone on all 5 measures. Combined
treatment was superior to fluoxetine on 2 measures. Fluoxetine alone was superior
to placebo on 3 measures and to CBT alone on all 5 measures. Additionally,
fluoxetine in combination with CBT showed a large effect size and fluoxetine
alone showed a moderate effect size on the Children’s Depression Rating
Scale-Revised and on the CGI, whereas CBT alone was not different from placebo.
Thus, we believe that the data show that fluoxetine in combination with CBT
is best, fluoxetine alone is effective but not as effective as combined treatment,
and that either fluoxetine-containing treatment is superior to CBT alone.